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Do the Clinical Features in Infantile-Onset Saccade Initiation Delay (Congenital Ocular Motor Apraxia) Correlate With Brain Magnetic Resonance Imaging Findings?

Salman, Michael S. BSc, MBBS, MRCP, MSc, PhD; Ikeda, Kristin M. MD

doi: 10.1097/WNO.0000000000000122
Original Contribution

Background: Infantile-onset saccade initiation delay (ISID) is a defect in saccade initiation. Other features may include impaired smooth ocular pursuit, developmental delay, hypotonia, and ataxia. Brain magnetic resonance imaging (MRI) can be normal or show supratentorial or infratentorial abnormalities. Our aim was to correlate the clinical features of ISID with brain MRI findings.

Methods: Detailed review of the English medical literature between 1952 and 2012 revealed 67 studies with possible ISID. Patients without a brain MRI or with inadequate information, Joubert syndrome, neurodegenerative disorders, and acquired saccade initiation delay were excluded. Ninety-one patients (age range, 3 months to 45 years) met the inclusion criteria and were divided into 3 groups based on their brain MRI findings: normal (n = 55), supratentorial abnormalities (n = 17), and infratentorial abnormalities (n = 19). The patients' clinical features including the direction of head thrusts, smooth pursuit, optokinetic response (OKR), tone, development, and coordination were compared and analyzed among the MRI groups using χ2 test.

Results: Horizontal head thrusts were significantly more common in patients with infratentorial abnormalities or normal brain MRI, whereas vertical head thrusts were more common among patients with supratentorial abnormalities (P < 0.0001). The slow phases of the OKR were significantly more likely to be impaired in patients with supratentorial or infratentorial abnormalities than in those with a normal MRI (P = 0.011). Other neuro-ophthalmological, neurological, and developmental features were similar among patients in the 3 neuroimaging groups.

Conclusion: The direction of head thrust and the integrity of the slow phases of the OKR are useful clinical indicators of possible sites of abnormality on brain MRI in patients with ISID.

Section of Pediatric Neurology (MSS), Children's Hospital and Department of Pediatrics and Child Health (MSS), Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; and Schulich School of Medicine and Dentistry (KMI), Western University, London, Ontario, Canada.

Address correspondence to Michael S. Salman, BSc, MBBS, MRCP, MSc, PhD, Section of Pediatric Neurology, Children's Hospital, AE 308, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada; E-mail:

The authors report no conflicts of interest.

© 2014 by North American Neuro-Ophthalmology Society